What Actually Happens to Patients Newly Diagnosed with Hepatitis C Virus Infecti

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What Actually Happens to Patients Newly Diagnosed with Hepatitis C

Virus Infection?

For optimal management, individuals who are infected with hepatitis C

virus (HCV) require referral to the care of a specialist. The

objective of the present study was to determine whether patients

newly diagnosed as anti-HCV positive are appropriately referred for

further investigation and management, and if not, to determine why

not.

The researchers studied patients tested for antibodies to HCV by

Nottingham Public Health Laboratory (Nottingham, UK) in a 2-year

period (2000-2002). The progress of newly diagnosed anti-HCV positive

patients into specialist clinics for further management was

documented.

For patients not referred for specialist care, a questionnaire was

sent to the clinician requesting the initial anti-HCV test, to

identify reasons for non referral. The answers to these questions

were used as the basis for this published report, which appears in

the April 2006 issue of The Journal of Viral Hepatitis.

Results

11,177 were tested for anti-HCV; 256 (2.3%) were newly diagnosed as

being anti-HCV positive.

Two percent of samples sent from primary care were anti-HCV

positive, compared to 18.8, 18.9 and 1.3% sent from prison, drug and

alcohol units, and secondary care, respectively.

About 64.3% of positive patients diagnosed in primary care were

referred to specialist care, compared to 18.4, 42.4 and 62.6% of

patients diagnosed in the other three settings.

One hundred and twenty-five (49%) newly diagnosed patients were

referred appropriately for further management.

68 of these attended clinic, 45 underwent liver biopsy and 26 (10%)

began treatment.

One hundred and thirty-one patients (51%) were not referred.

In 54 cases, there was no evidence that the anti-HCV positive result

reached the patient.

In 15, referral was considered but rejected, and 20 patients were

referred to non-HCV-specialists (their general practitioners or to

genito-urinary medicine).

The study authors conclude, " …Less than 50% of newly diagnosed anti-

HCV positive patients are referred to an appropriate clinic for

further investigation and management. [The] reasons for this are

multifarious and complex, reflecting both systems failure and patient

choice.

" Unless these are understood and addressed, the Department of Health

Hepatitis C Strategy (2002) and Action Plan for England (2004) will

fail to achieve their intended objectives.

04/04/06